Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel.
J Clin Neurosci. 2020 Nov;81:27-31. doi: 10.1016/j.jocn.2020.09.003. Epub 2020 Sep 25.
Our study aim is to evaluate the accuracy of freehand external ventricular drain (EVD) placement, without the use of adjuncts to placement, immediately following a large decompressive hemicraniectomy (DC). We performed a retrospective cohort analysis comparing patients who underwent freehand EVD placement immediately after a DC, to those who underwent freehand EVD placement without DC. Computed tomography (CT) studies were used to assess accuracy based on catheter tip location. Intracranial catheter length, pre- and post-operative Evan's Index, and midline shift pre- and post-operatively were analysed as separate variables in each group. A previously described grading system was used to assess the accuracy of free hand EVD placement. There were a total 110 patients overall; DC group, n = 50; non-DC group, n = 60. There was a significant reduction from pre-operative midline shift to post-operative midline shift in the DC group (9.13 vs 6.02 mm; p = 0.0064). There was no significant difference in accuracy between the two groups (p = 0.8917), and similar rates of Grade 1 - i.e. optimal - catheter tip location (DC = 78% vs non-DC = 81%) were found. All analysed variables comparing both Grade 1 subgroups (pre- and postoperative Evan's Index, and midline shift) showed significant differences between them. Mean catheter length in Grade 1 EVD placement showed a statistically significant difference between the DC and non-DC groups (63.78 vs 59.96 mm, respectively; p = 0.009). An EVD, after DC for traumatic and non-traumatic intracranial pathologies, can be accurately placed by freehand.
我们的研究目的是评估在进行大骨瓣减压术后（DC）即刻不使用辅助手段徒手进行外置脑室引流（EVD）置管的准确性。我们进行了一项回顾性队列分析，比较了立即在 DC 后进行徒手 EVD 置管的患者和未进行 DC 而进行徒手 EVD 置管的患者。根据导管尖端位置，使用计算机断层扫描（CT）研究来评估准确性。分析了颅内导管长度、术前和术后 Evan 指数以及术前和术后中线移位作为每组的单独变量。使用先前描述的分级系统评估徒手 EVD 置管的准确性。总共有 110 例患者；DC 组，n=50；非 DC 组，n=60。在 DC 组中，术前中线移位到术后中线移位有显著减少（9.13 毫米对 6.02 毫米；p=0.0064）。两组之间的准确性没有显著差异（p=0.8917），并且发现了类似的 1 级（即最佳）导管尖端位置的发生率（DC=78%对非 DC=81%）。比较两个 1 级亚组（术前和术后 Evan 指数和中线移位）的所有分析变量均显示出它们之间的显著差异。1 级 EVD 置管的平均导管长度在 DC 和非 DC 组之间显示出统计学显著差异（分别为 63.78 毫米和 59.96 毫米；p=0.009）。对于创伤性和非创伤性颅内病变，在 DC 后可以通过徒手准确放置 EVD。
